Legal, Regulated Heroin Could Have Saved Philip Seymour HoffmanAddicts need medical support like heroin maintenance, which is illegal in the U.S. thanks to the war on drugs.A great entertainer overdosed on heroin two weeks ago. He was found dead, a needle hanging from his arm. Dozens of empty drug baggies were found strewn around his apartment.

He was considered a fantastic actor. Influential. Powerful. Insightful. Potent. Everyone, by this time, knows this man’s name. It’s been plastered across the media landscape not just in the United States, but worldwide: Philip Seymour Hoffman.

In the days since, there’s been all kinds of chatter about the evils of heroin or the need for better drug education. But there hasn’t been much talk about the painful, obvious, cold, hard truth: Heroin should be regulated—and not only because science says so, but because, (and again, let’s be honest) look around.

Drug prohibition didn’t keep us from this great cultural loss. In fact, drug prohibition causes thousands of unnamed human losses we suffer day after day, month after month, year after year in this country. Think of the person you know (or your friend who knows someone) who has died because of a heroin, or opiate, overdose. Say their name—because they deserve to be remembered, as much as Hoffman does. And because in a health-centered, rather than law enforcement-centered, world, they didn’t have to die.

***

According to the Center for Disease Control, “opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths” and “38,329 people died from a drug overdose in the United States in 2010.” According to the Office of National Drug Control Policy, from 2006-2010, that was a 21% increase.

Death by heroin increased 45 percent during the same time frame.

Allan Clear is executive director of the Harm Reduction Coalition, a non-profit organization that advocates for injection drug users in the United States. When I contacted Clear to comment, he started by reviewing Hoffman’s history. “He had problems when he was younger, got help, then he was using pills, then he switched to heroin,” Clear noted.

In fact, pharmaceutical drugs like Oxycontin that are one of the primary reasons we have an opiate addiction crisis in the U.S. in the first place.

“A fantastic amount of [pharmaceutical] drugs get out there,” said Clear. “Cutting back on prescribing can help. Part of the problem is that opiate drugs are out there in too vast quantity. The reason we have a pain pill problem in this country is because of the historic under treatment of pain. Now we have over prescribing.”

The pharmaceutical-to-heroin transition is often made when one’s opiate prescription ends or is no longer covered by insurance, whether you’re rich and famous or poor and on Medicare.

“If we had a maintenance program,” Clear continued, “his dependence would’ve been managed by the medical community, and he wouldn’t have needed to graduate to street heroin.”

Maintenance? That’s a program where pharmaceutical, clean heroin (or other opiate) is administered in a controlled, clinical setting to addicts who have not benefited from other, more traditional treatments such as methadone.

“The advantage is he can understand what’s going into his body and what his dosage should be,” said Clear. In addition, “He doesn’t have to run out and buy drugs, so it’s not a struggle. It takes away anxiety. That kind of constancy and quality control would begin to mitigate some of the adverse reactions to heroin.”

In other words, had Hoffman been on heroin or opiate maintenance (if we had such a thing in the United States), it would have been clean, pharmaceutical grade—not cut by unknown drugs—the dose he took would have been known. It might not have killed him, and he would’ve had medical support throughout the process, so in case of an emergency, he might have been saved.

But many people believe that “there is no safe batch of heroin. It’s a killer drug,” as Boston mayor Martin J. Walsh recently said. While that is true of street heroin, where the shadowy dealer is in control, it’s not true of a pharmaceutical, medical care system of dealing with opiate addiction, such as Clear suggests.

Alex Wodak is President of the Australian Drug Law Reform Foundation. He points to a mountain of evidence that heroin maintenance is cost effective and better for the public health than law enforcement-centered prohibition, calling it “an evidence-based drug policy, rather than the fantasy-based drug policies of the United States.”

“The threshold issue is redefining drugs as a health problem,” Wodak said. “Once that switch is made, then most of the funding has to increase via health and social investments. Investing money in law enforcement is a waste of time.”

Thomas Kerr, Associate Professor in the faculty of medicine at the University of British Columbia, has run several NIH-funded studies of injection drug users. He’s also one of the lead scientists evaluating Vancouver’s supervised injection facility, Insite. (A supervised injection facility is a place where addicts can take their drug, under the supervision of medical personnel. The site doesn’t offer illegal drugs—they simply provide a clean, safe environment, so the person isn’t using dirty needles or if they OD or want help medical staff is on hand.)

One of the major benefits of a regulated drug market, Kerr said, is “you can be assured of the dose and purity. So many deaths happen as a result of lack of knowledge or purity. Sometimes the heroin can be cut with impurities that make people sick. When people are consuming a drug that is illegal and they are marginalized for their use, they don’t know the purity or strength.”

By keeping these drugs illegal, and forcing people to turn to an illegal market, “we are causing more harm than the drugs themselves. Imagine every time you wanted to have a drink, you had to go to an unknown source, and every now and then, you got alcohol that contains paint remover. It would burn your esophagus and you’d need to be hospitalized. It seems crazy and makes no sense. But we’ve tolerated that with drugs like heroin.”

There have been numerous heroin trials around the world, including Spain, Switzerland, the Netherlands, Germany, Canada, and England says Kerr, and they show that “when you provide people with pharmaceutical heroin, they can return to work, reduce their involvement in criminal activities, and reduce their illicit use.”

Additionally, “We’re not talking about a one-off, poorly conducted study. There have been numerous trials conducted in multiple countries with the same results. There is no academic debate about the value of prescribed heroin. It’s really a political and ideological debate rooted in an archaic system of drug and law control. That in turn creates stigmatizing and discriminating. The WHO [World Health Organization] agrees this is a health issue.”

But others argue that heroin maintenance does nothing more than use taxpayer money to support, or even encourage, addiction. Calvina L. Fay, Director of the Drug Free America Foundation, reports, “Most opiate addicts are polytoxicomaniacs (addicted to several drugs) and [heroin maintenance] programs would supply them with their base drug, free of charge… Psychic effects of opiates make it very difficult to get in touch with the addict emotionally; therefore, psychotherapy is almost impossible… [and] A patient in a heroin maintenance program is still under the influence of the drug and has no motivation to begin a therapy leading to abstinence.”

***

The United States might seem quite far away from heroin regulation. But there are other tweaks to attitude and policy that can be made.

Coming out of treatment, Clear said people “should be prepared for not only how they remain not using, but they need to be equipped for what to do if they decide to pick up again—Or if someone they come across is.”

This can include making anti-addiction drug buprenorphine available to them, as well as anti-overdose medication naloxone. “In France, they vastly expanded buprenorphine and the overdose rate fell,” said Clear. “It’s still not as widely used as it could be. Someone who has that history should have that option—and there are not many treatment facilities in the United States that go that route. [It] can be a lifesaver. I’ve known people who have a history of using, when they know they’re going in to a situation [where they might want to use heroin], they take 2-4 milligrams of buprenorphine, to make sure they don’t pick up.”

In other circumstances, naloxone (also known as Narcan) might work. It’s an injectable drug that saves people from dying from heroin overdoses by knocking the opiates off the receptors in the brain—so the person overdosing starts breathing again. (That’s frequently how heroin overdoses kill: the person stops breathing.) “It’s a weird thing to say,” said Clear, “but it is a miracle drug. You have a person who is turning blue and dying, and you give them this drug, and they’re breathing again. Suddenly, they’re not high. If I were to take it with no opiates in my system, I’d have no adverse reaction to it. It’s completely safe.” Yet the availability of the drug, which Clear says should be made available to everyone leaving opiate treatment, is patchwork across the country. Some jurisdictions allow family members of addicts to have it. Others permit only the police and EMTs to carry it. Boston Mayor Walsh just announced all Boston police and EMTs will now carry it after three people died of heroin overdoses in just 48 hours.

It all comes down to “rethinking the way that we utilize medication,” said Clear.

There’s “also as a protective factor when it comes to overdose. We have a tightly controlled clinic system that isn’t convenient for people. Then we have the criminal sanctions, which leads to secrecy. So many people have had their lives destroyed, especially people of color… Those sanctions make it harder to come above ground and seek support, when you don’t know what the consequences are.”

“There are many scenarios where someone overdoses, and the people they are with leave because they are afraid,” Clear continued. “People have been charged with murder for supplying the [injection] that kills them. Just taking the criminal justice system out of it would be a major step forward.” Hence, the need for more “good Samaritan” laws that protect people who call for help when someone is overdosing.

Clear also says that the popular idea in the treatment industry—the idea of anonymity, “is a bit of an issue. It would be helpful if people knew how many had these issues, because it makes it less of an issue when so many people have the issue.”

Prescription drug Dilaudid, said Clear, (as well as others interviewed for this article), is another solution. An addict could be prescribed Dilaudid with out the stigma and resonance that a drug like heroin carries with it.

Many advocates say public health approaches such as these are big step towards ending the stigmatization of drug users, and say that by removing criminal sanctions and improving access to health-oriented programs, the addicts can stabilize their lives and reduce their involvement in crime.

Others like Fay say that even funding needle-exchange programs is a waste of resources. In Denmark, when there was a heroin maintenance initiative, the opposition to the idea also came from those who had concerns about funding.

And of course not all maintenance programs are created equal, and the opiate addiction drugs we already use regularly, such as methadone, have their problems, too, including being difficult to detox from. Many neighborhoods dislike having methadone clinics in their communities, often because of how the methadone is distributed: the addicts must show up at the clinic every day for their dose, frequently lining up outside, to the disdain of neighbors.

Robert Hämmig, medical director in the addiction department—Bern University clinic for Psychiatry & Psychotherapy, and President of the Swiss Society for Addiction Medicine, said that in Switzerland, the same NIMBY problem happens with the heroin clinic there, too, because the addicts cannot take their dose home, so they stay nearby in order to take their dose twice a day, 365 days a year. The most severe side effect some users experience from heroin maintenance is osteoporosis after long-term use. Other than that, says Hämmig, the social side effects of it are related to how it is restricted—such as the lines of people outside the clinic.

Legalization of prescription-based opiate maintenance probably will not eradicate the black market, either.

Still, “It’s time for a shift,” in policy, said Kerr, especially now that “people realize the system of control and punishment is the worst policy.”

Yes, it is time to legalize all drugs and treat the addiction as it should be....a medical issue. Shift the money from the 'War on Drugs' into education and treatment programs and let the law enforcement community focus on actual legal issues.

_________________

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February 18th, 2014, 11:04 am

Blueskies

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Joined: September 13th, 2007, 12:43 pmPosts: 2862

Re: Legalize Heroin and other opiates?

All drugs should be legal, no question whatsoever.

February 18th, 2014, 12:29 pm

DJ-B

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Joined: April 5th, 2007, 5:51 pmPosts: 2327

Re: Legalize Heroin and other opiates?

I agree in decriminalization. I don't agree in funding other peoples drug habits or treatment. not sure where that puts me on the issue.

I can't deny that in the current situation, the war on drugs is an abject failure on all fronts.

February 18th, 2014, 2:50 pm

TheRealWags

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Joined: December 31st, 2004, 9:55 amPosts: 12296

Re: Legalize Heroin and other opiates?

DJ-B wrote:

I agree in decriminalization.

Keep in mind that decriminalization likely still keeps the dealers rich & keeps the product dirty/unsafe; also untaxed.

Could this be a bit of a knee jerk reaction to PSH's death? What would Nancy Regan say?

I'm pretty libertarian in general and some of the studies have pretty interesting results, but lets tap the breaks on making everything legal all of a sudden.

We have 1.5 months of legal mary jane, and while both states that approved it made it to the Super Bowl, lets use this as a real world case study for what happens in real life once a drug is made legal. Even then, I wouldn't compare that to heroin.

I know very little about heroin, so this is an area I know little about. I'd agree, we need to start shifting the focus on the war on drugs. But we need to phase in steps and review the various outcomes before we just make everything legal. With a drug this "hard", you have to be careful of the unintended consequences of legalization.

Just about anyone who wants to use heroin can get it -- it isn't that hard to obtain.

Meanwhile, the money spent on it funds organized crime, and to some extent, terrorist activities.

Ban its use public places. Make it difficult to purchase and require the buyer be 21. Add in any other common sense regulations you want. But the costs of keeping it illegal far outweigh the benefits.

February 18th, 2014, 6:47 pm

aManNamedSuh

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Joined: July 14th, 2005, 11:58 amPosts: 817

Re: Legalize Heroin and other opiates?

Blueskies wrote:

What exactly does keeping it illegal accomplish?

Just about anyone who wants to use heroin can get it -- it isn't that hard to obtain.

Meanwhile, the money spent on it funds organized crime, and to some extent, terrorist activities.

Ban its use public places. Make it difficult to purchase and require the buyer be 21. Add in any other common sense regulations you want. But the costs of keeping it illegal far outweigh the benefits.

I would simply say that making it illegal put a stigma on them that could potentially prevent someone from trying the drug in the first place.

February 18th, 2014, 9:28 pm

Blueskies

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Re: Legalize Heroin and other opiates?

That's a real possibility, but I don't think you'd see drug use increase meaningfully as long as the drugs are properly regulated and stigmatized. I guess we'll get a better idea once marijuana becomes legal everywhere -- although that won't be a perfect proxy, given that it isn't nearly as harmful.

When the entire US legalizes marijuana (which it will sometime in the next decade) will any non-pot smokers here start smoking pot? I'll admit it -- years ago, I used to toke from time to time, but have no interest in it now, and wouldn't go back to smoking even if it were legal.

February 19th, 2014, 10:20 am

aManNamedSuh

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Joined: July 14th, 2005, 11:58 amPosts: 817

Re: Legalize Heroin and other opiates?

Probably not, but that's because I'll still associate it with being illegal. When the youth of today get older that stigma will be completely gone so it will be hard to keep any fear of the drug going. This references more to harder drugs needing fear, while I think weed is much more harmful than people lead on I still understand it's nothing compared to Heroin or Cocaine.

February 19th, 2014, 10:38 am

Blueskies

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Re: Legalize Heroin and other opiates?

A little less than half of American teenagers smoke pot, yet fewer than 2% have ever used heroin, and both drugs are illegal.

In other words, I think people are more intelligent than you give them credit for.

February 19th, 2014, 11:18 am

aManNamedSuh

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Joined: July 14th, 2005, 11:58 amPosts: 817

Re: Legalize Heroin and other opiates?

Blueskies wrote:

A little less than half of American teenagers smoke pot, yet fewer than 2% have ever used heroin, and both drugs are illegal.

In other words, I think people are more intelligent than you give them credit for.

Probably not, but that's because I'll still associate it with being illegal. When the youth of today get older that stigma will be completely gone so it will be hard to keep any fear of the drug going. This references more to harder drugs needing fear, while I think weed is much more harmful than people lead on I still understand it's nothing compared to Heroin or Cocaine.

There's just no evidence to support the idea that week is harmful. Or at least, there is evidence showing it to be far less harmful than alcohol or tobacco. For example, there are areas where the effects of alcohol and weed are similar (impaired coordination, balance, judgement). However, it is nearly impossible to fatally overdose from marijuana as you can with alcohol. It's almost impossible. Also, there is research showing that alcohol is much more likely to react with other medications than weed is, due to the way the human body metabolizes alcohol and medicine.

The bottom line is that there is a ton of evidence showing weed is at worst no more harmful than alcohol, and it makes no sense for it not to be legalized and regulated just like alcohol or cigarettes are.

_________________"Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence." - John Adams

“The good thing about science is that it's true whether or not you believe in it.” - Neil deGrasse Tyson

February 19th, 2014, 2:25 pm

aManNamedSuh

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Joined: July 14th, 2005, 11:58 amPosts: 817

Re: Legalize Heroin and other opiates?

Touchdown Jesus wrote:

aManNamedSuh wrote:

Probably not, but that's because I'll still associate it with being illegal. When the youth of today get older that stigma will be completely gone so it will be hard to keep any fear of the drug going. This references more to harder drugs needing fear, while I think weed is much more harmful than people lead on I still understand it's nothing compared to Heroin or Cocaine.

There's just no evidence to support the idea that week is harmful. Or at least, there is evidence showing it to be far less harmful than alcohol or tobacco. For example, there are areas where the effects of alcohol and weed are similar (impaired coordination, balance, judgement). However, it is nearly impossible to fatally overdose from marijuana as you can with alcohol. It's almost impossible. Also, there is research showing that alcohol is much more likely to react with other medications than weed is, due to the way the human body metabolizes alcohol and medicine.

The bottom line is that there is a ton of evidence showing weed is at worst no more harmful than alcohol, and it makes no sense for it not to be legalized and regulated just like alcohol or cigarettes are.

That's kind of like closing the gate after the horse got out though. The US tried to stop alcohol but it failed. Saying something isn't as bad as something else that is legal so therefore should be legal itself is kind of misleading. It would sort of be like saying heroin can kill you but walking in front of a moving train isn't illegal and you can die from that more times than using heroin so heroin should be legal.

That's kind of like closing the gate after the horse got out though. The US tried to stop alcohol but it failed. Saying something isn't as bad as something else that is legal so therefore should be legal itself is kind of misleading. It would sort of be like saying heroin can kill you but walking in front of a moving train isn't illegal and you can die from that more times than using heroin so heroin should be legal.

I don't think that's an apt comparison at all. You're comparing two completely different things (yes I know you're trying to be ridiculous). Comparing alcohol with weed is apt because both are substances that people use to get a good feeling. But fine, we'll throw the comparisons out. Here's a fact: there has never been a known death from overdose of weed. It just doesn't happen. In fact, according to US government research, a person would have to consume approximately 1/3 of their bodyweight in marijuana in about 15 minutes in order to overdose and die. That's if they are ingesting it. If they were smoking it, that increases to about 2/3 of their bodyweight in 15 minutes. This is basically impossible. Plus, there are known medical benefits, and there is some research showing that weed smokers actually have a lower incidence of lung cancer than non smokers (of any type). This is thought to be because THC kills helps kill or inhibit tumor growth.

Bottom line: marijuana is a plant that has no known history of causing death, does impair some senses/functions, and has some medical benefits. That sounds a lot to me like many drugs that are considered medicines, and those are legal and regulated. Oops, there I go making comparisons again...

_________________"Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence." - John Adams

“The good thing about science is that it's true whether or not you believe in it.” - Neil deGrasse Tyson

February 19th, 2014, 3:31 pm

Blueskies

Player of the Year - Offense

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Re: Legalize Heroin and other opiates?

I don't really think there's any debate over marijuana legalization anymore. That ship has more or less sailed, and I suspect the few people left who still want to keep pot illegal just haven't done their homework. If they did a little reading, they'd come around.

The bigger question is really other drugs -- drugs that are objectively harmful and can really mess people up: cocaine, heroin, meth, etc. I lean towards full legalization, but I can sympathize with the other side.